Revisional Surgery After Failed Laparoscopic Sleeve Gastrectomy: Retrospective Analysis of Causes, Results, and Technical Considerations

May 12, 2017Obesity surgery

Follow-up Surgery After Failed Weight-Loss Sleeve Procedure: Past Causes, Outcomes, and Surgical Details

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Abstract

Of the 500 patients who underwent primary laparoscopic sleeve gastrectomy (LSG), 32 required revisional surgery after a failed procedure.

Weight regain, poor weight loss, and gastroesophageal reflux disease (GERD) were the most common reasons for requiring revisional surgery.
Revisional laparoscopic sleeve gastrectomy (r-LSG) was performed in 23 patients, while 9 patients underwent revisional laparoscopic Roux-en-Y gastric bypass (r-LRYGB).
Complete sleeve pouch dilation was observed in 10 patients, with residual fundus and antrum dilation found in 5 and 8 patients, respectively.
The r-LRYGB procedure addressed GERD symptoms in 6 patients, and 3 patients underwent the procedure due to high-caloric food intake.
Revisional surgeries had a mean operative time, length of hospital stay, and complication rates that were significantly higher than those of the overall cohort.

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BACKGROUND: A failed laparoscopic sleeve gastrectomy (LSG) presents a challenging problem for bariatric surgeons. The aim of this study was to evaluate the indications, treatment strategies, and surgical outcomes of patients who underwent a revisional surgery after a failed LSG.

METHODS: This retrospective study included the outcomes of 32 patients who required a revisional surgery from a series of 500 primary LSGs. The patients' demographic data, indications for revisional surgery, perioperative complications, and postoperative outcomes were recorded.

RESULTS: A total of 500 patients underwent primary LSGs during the study period, and 32 of these patients were subjected to revisional bariatric surgery after a failed LSG. Weight regain, poor weight loss, and gastroesophageal reflux disease (GERD) were the most common causes of revision. A revisional LSG (r-LSG) was performed in 23 patients, while 9 patients received a revisional laparoscopic Roux-en-Y gastric bypass (r-LRYGB). There were complete sleeve pouch dilations in 10 patients. A residual fundus and antrum dilation was detected in 5 and 8 patients, respectively. The r-LRYGB procedure was performed for GERD-related symptoms in 6 patients and 3 other patients underwent r-LRYGB due to the intake of high-caloric foods. The mean operative time, length of hospital stay, and complication rates of revisional surgeries were significantly higher than the total cohort.

CONCLUSIONS: Although r-LSG and r-LRYGB seem to be safe and effective treatment options after a failed LSG, revisional procedures were associated with an increased complication rate. Attention to technical details of the primary LSG may reduce the revision requirements.

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Revisional Surgery After Failed Laparoscopic Sleeve Gastrectomy: Retrospective Analysis of Causes, Results, and Technical Considerations

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